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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 588-5147 8:00- 4:30
<br /> 24 HOUR CODE-A-PHONE: 588-7g04
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<br />~ ~ SI~ ~ER: 94-00755
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<br />~ _,.J I I ~ - ~ .... .,== .... ~ .....
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<br />TYPE: ON-SITE SEWASE
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<br />PERMIT OR ~-~PLiCATION NO: 9053059
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<br />CONTRACTOR, NO.
<br />CAUGEMAN, ELIZABgTH '.."""
<br />SAM~
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<br /> WATER sUPPLY: PW
<br /> TEST HOLES READY:
<br /> SITE EVALUATION NUMBER:
<br /> EXISTING TANK SIZE: 750
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<br />t'SEPT~' T~NM PUF~PED. 1/26/94
<br /> PREVIOUS MO. BEDROOMS:
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<br />PHONE: 749-1503
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<br /> ITEM ' ": "' ' :" ',' '" .... ''" '..' " QUANTITY AMOUNT
<br />ANNUAD EVAL. - EMP OR ND$~.P ,~H', ,',..', .'..'.......` :..,.'.'..,.,',, ,',, .: 1 $90.00
<br /> .. .... "...' "":' :' '~' ':"[.:: :","~T~ ~' i~s'~:S'~ .~ E ~ S ~ O. o o
<br /> · ..,-:..'P~EY~OU~',RE~I~T¢: $0.00
<br /> ............. :;'.:. TH~'t"~EC~P~ ..... ' $90.00
<br /> · '"-. ; .'L..:'::.:.-,,',.-.':',,,-',:', ','
<br /> ',' ":'",Y':':'":"'"'"":'""::.':::.'~ANCE'~UE: ,',,,',? 80.00
<br />~A~E: ,TERESA A^F/9~M~ },.' "i ",:,," I ,..:.......: .... ....: ' .'.~iRECEIPT NO: 55521
<br />R~;~.~,~¥ED BY: MB~ ~/% r~:~;-'.:~':, , ,,,, ,,,,/,',.,:,:,,,,.......... i .....:~ ..,..~...,,, '~TYPR: CK CHECK ~: 316S
<br />................ ~_~_.~=-~-~_.~--:~J;~ .... ~--~ .... ~_~'~'~ ..........................
<br />s~-; ','~,:~ Oocu~s~T ~b~.,-.~s~uZ~$~S O~'.o~s~S,'~vA~ SYSTS~.
<br />..................... ~--T--~, .... ~--=~ ~.--~ ,. , , , --~ ~-- ~ ..............................
<br />· THI$'I~S NOT A P~R~IT,.. ~'~t$.: iAPPDtCATION ,BlrST ~ ,'~OS~ a ~I~ PR~ESS ~ERE THE
<br />FOLL0W,,,,'c ~UST SE COMPLETEDi ".I~ ~S",T~ ' RES~0NSI.B:ILz?Y :'OF THE APPLICANT TO ASSURE TEAT
<br />ALL NECZSSARY I~FORMAT}ON.E~S 'BmM~.':PRO~IDEDi.' ,,,,",'J ..
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<br />OFFICE COPY
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